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The Province of Affliction

Illness and the Making of Early New England

In The Province of Affliction, Ben Mutschler explores the surprising roles that illness played in shaping the foundations of New England society and government from the late seventeenth century through the early nineteenth century. Considered healthier than people in many other regions of early America, and yet still riddled with disease, New Englanders grappled steadily with what could be expected of the sick and what allowances were made to them and their providers. Mutschler integrates the history of disease into the narrative of early American social and political development, illuminating the fragility of autonomy, individualism, and advancement . Each sickness in early New England created its own web of interdependent social relations that could both enable survival and set off a long bureaucratic struggle to determine responsibility for the misfortune. From families and households to townships, colonies, and states, illness both defined and strained the institutions of the day, bringing people together in the face of calamity, yet also driving them apart when the cost of persevering grew overwhelming. In the process, domestic turmoil circulated through the social and political world to permeate the very bedrock of early American civic life.


"An important contribution to the historiography of illness and public health in early America. . . . Mutschler’s approach allows him to successfully balance what was representative of the era and what was distinctive about this particular location under his purview. Moreover, Mutschler’s style and emphasis on narrative makes the book accessible for those who do not specialize in the history of medicine. His work integrates illness with other forms of lived experience and demonstrates to his audience the merit of considering sickness in New England society and as an important lens for all historians of early America."

William and Mary Quarterly

“Mutschler examines in great detail, and with admirable skill, how sickness affected life in early Massachusetts. . . Mutschler is a fluid writer, with an admirable mastery of the relevant primary and secondary sources. . . Mutschler capably enlarges and deepens our understanding of daily life in New England and how the health safety net may have contracted rather than expanded over time as responsibility for health care moved away the individual and home to corporate and governmental resources.”

Social History of Medicine

“Families struggling to care for loved ones. Governments determined to cut back on medical costs. Populations quarantined to stop the spread of disease. These scenes from colonial New England are as current as today’s news. TheProvince of Affliction reveals a world surprisingly familiar, yet profoundly different from our own. In depicting this world, Mutschler is original, ambitious, masterful in his command of diverse sources, and a lively and fluent writer. He also forecasts the ideological origin of our current plight: the ethos of individualism that emerged in the wake of the Revolution, which built a new world of freedom and risk without a social safety net.”

Robert A. Gross, University of Connecticut

“Timely for its historical reflections on the challenges posed by disease, The Province of Affliction documents the resilient responses of early New Englanders to the regular occurrences of serious illness. Mutschler provides a poignant and pointed account of a world in which colonial settlers regularly stretched their capacities to tend to the sick and dying.”

Kathleen Brown, University of Pennsylvania

The Province of Affliction provides a new lens into the experiences of New England colonists that broadens and deepens past scholarship. While New Englanders may have lived a long time, boy, did they suffer! Mutschler’s fascinating book is an eye-opening examination and raises a host of questions about how we measure and evaluate medical progress.”

David K. Rosner, Columbia University

“A work noteworthy for both what it has to teach about its designated historical period as well as about some of the most pressing challenges of that time that we continue to face today.”

The Well-Read Naturalist

Table of Contents



1.         A Tour of the Province: October 18, 1769
2.         Illness in the “Social Credit” and “Money” Economies of Eighteenth-Century New England


3.         Family Competency: Scenes from the Life Course of Illness
4.         Household Competency: Work, Responsibility, and Belonging


5.         Smallpox, Public Health, and Town Governance
6.         The Domestic Costs of War: Wartime Afflictions


7.         Colonial Pensioners, the Revolutionary Invalid Corps, and the Advent of “Decisive Disability”
8.         State Paupers and Patients

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